资源描述:
《非小细胞肺癌(NSCLC)目前治疗进展及未来发展方向》由会员上传分享,免费在线阅读,更多相关内容在教育资源-天天文库。
1、ChandraP.BelaniMDProfessorofMedicineUniversityofPittsburghSchoolofMedicineCo-Director,Lung&ThoracicCancerProgramUniversityofPittsburghCancerInstitute非小细胞肺癌(NSCLC)目前治疗进展及未来发展方向NSCLC:诊断时分期及生存Mountain.Chest.1997;1710-1717.StageIStageIIStageIIIStageIV020406080100生存比例诊断时分期StIStIIStIIIAStIIIBStIV两药方案一
2、线治疗晚期NSCLC的合理性GoodPS患者1990s:含铂方案是治疗标准NSCLCCollaborativeGroupBMJ.1995;311:899-909目前ASCO指南:含铂两药方案或非铂两药方案是具有较佳PS晚期NSCLC的治疗标准Pfisteretal.JClinOncol.2004;22:330-353ECOG1594:研究设计分层:分期:IIIBvsIVPS:0–1vs2体重降低:5%vs5%CNS转移:novsyesArmA:顺铂+泰素泰素:135mg/m2/24hDay1顺铂:75mg/m2day2q3wkArmD:卡铂+泰素泰素:225mg/m2/3hDay
3、1卡铂:AUC6Day1ArmC:顺铂+多西他赛多西他赛:75mg/m2Day1顺铂:75mg/m2Day1ArmB:顺铂+双氟胞苷双氟胞苷:1000mg/m2Days1,8,15顺铂:100mg/m2Day1q4wkq3wkq3wkSchillerJH,etal.ProcASCO36thAnnualMeeting.2000;19:abstr2.SchillerJH,etal.NEnglJMed.2002;346:92-98.RANDOMIZEE1594TAX326研究设计RANDOMIZE分层因素:疾病分期IIIBvs.IV和区域US/CanadaSouthAmeri
4、caEurope/LebanonIsraelSouthAfrica/AustraliaNewZealandResponseassessmentevery2cycles多西他赛75mg/m2IV卡铂AUC6IVQ3wks去甲长春花碱25mg/m2IVD1,8,15&22顺铂100mg/m2IVD1Q4wks多西他赛75mg/m2IV顺铂75mg/m2IVQ3wksvs.orTAX326总生存Fossellaetal.JClin.Oncol.2003;21:3016-3024.100806040200Survival(%)03691215182124273033Time(months)T
5、CVC100806040200Survival(%)03691215182124273033Time(months)P=.657,adjustedlog-ranktestTCbVC1-ysurvival46%vs41%withVC2-ysurvival21%vs14%withVCMediansurvival:11.3vs10.1moP=.044,adjustedlog-ranktest1-ysurvival38%vs40%withVC2-ysurvival18%vs14%withVC«RANDOMIZE方案设计分层前6个月体重降低:<5%vs≥5%疾病分期:湿性IIIB,IV是否脑转
6、移:双氟胞苷1000mg/m2d1,8泰素200mg/m2d1q21days双氟胞苷1000mg/m2d1,8卡铂AUC5.5d1q21daysArmA:双氟胞苷+卡铂ArmB:双氟胞苷+泰素ArmC:泰素+卡铂泰素225mg/m2d1卡铂AUC6.0d1q21days非铂方案ASCOAbstract#7025CoalitionTrial生存结果Arm3Arm2Arm1泰素150mg/m2+卡铂AUC=2(连用6周,休2周),then泰素100mg/m2+卡铂AUC=2(连用6周,休2周)*泰素100mg/m2+卡铂AUC=2(连用3周,休1周)*泰素100mg/m2(连用3周,休1周
7、)+卡铂AUC=6(d1)*SCHEMABelanietal,JCO21:2933-39,2003泰素每周方案联合卡铂初始化疗后泰素每周方案维持治疗晚期NSCLC–随机II期临床试验*泰素/卡铂初始化疗后取得CR,PRorSD的患者随机接受泰素70mg/m2/wk维持治疗或观察疗效/毒性Arm1 Arm2Arm3中位生存时间49wks31wks40wks(p=0.077vs1)(p<0.45vs1)中位TTP30wks21wks27wks(p=